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01/17/23
CONDITIONAL USE PERMIT
STREET RIGHT-OF-WAY DEDICATION AGREEMENT
LOCATION/ADDRESS: _ N Go 'J • -PC•- r ` ", A � 'L
DATE: Q q I I--? 1 -21M,
I OCKE FOR MMEE-TING ON:
I, fwFA CV3 , do hereby agree / disagree to dedicate to the
public any nmdej right-of-way as required by the Master Street Plan for a public street abutting
propert caned by me adjacent to the property requested far a conditional use permit.
I, , agree / disagree to provide at my expense an
easement deed an or other documents as necessary conveying such right-of-way to the public.
APPLICANTIOWNER Yam } �J DATE 17
(If the above signature represents an applicant, attachment of a letter is required authorizing this
person to act in behalf of the tide -holder-)